Descending nerve-sparing radical prostatectomy--results and consequences

Nerve-sparing radical prostatectomy is the therapy of choice in selected prostate cancer patients. In an internal quality control including a questionnaire, our nerve-sparing radical prostatectomies have been analysed for oncological and functional results as well as patient satisfaction. 171 consecutive nerve sparing radical prostatectomies have been analysed, 123 bilateral, 48 unilateral. The median follow-up was 26 (2-56) months. The operations were performed by 5 surgeons. In 27% the T-category and in 12% the Gleason score had been understaged preoperatively, 9% had positive margins and in 4% lymph nodes were positive. 99% of the patients stated that they would again prefer the operation as treatment of first choice. 95% were satisfied with their postoperative situation. 53% of the patients had erections sufficient for sexual intercourse following the bilateral, 25% following the unilateral nerve-sparing procedure. The time until recurrence of erections was 1 month in 42%, 6 months in 90% and 12 months in 100% of the potent men. 90% of all patients within the observation period are fully continent, 10% of the patients need more than 1 pad. The intersurgeon variability is 77-98% for continence and 25-60% for potency. Patient satisfaction, oncological and functional results are good. The understaging rate suggests the necessity for better patient selection including re-biopsy and reference histology. 27% would have been undertreated by brachytherapy as alternative treatment. Intensive surgeon teaching is mandatory.